Environmental exposures in the neonatal intensive care unit impacting neurodevelopmental outcomes for neonates

Critically ill preterm and term neonates are uniquely vulnerable to and constantly confront potential harmful and unintended exposures in every aspect of their care, including diagnostic imaging, sensory environments, medications, nutrition, blood products, and device exposures. The rapidly changing pathology, physiology, and metabolism of these infants, along with a lack of treatments tailored to the needs of neonates, lead to unintended negative consequences with impacts reaching far out into adulthood. Families, nurses, clinicians, and researchers provide the best care for neonates with the resources and knowledge available, but more needs to be done from the healthcare policy and societal levels. More research is needed to understand the negative impacts of environmental exposures on neonates and children in general. Concerted efforts should focus on eliminating known toxic and harmful substances from commercial products used in neonatal care, and alternatives should be made available. Resource allocation is needed by community leaders and health policy makers, through regulations and incentives, to ensure that neonates and children can have healthy, happy, and productive lives. Our society should be judged by how we care for and treat this most vulnerable population, who deserve environments and treatments free from unintended, unnecessary harmful exposures. IMPACT: Technological advances have significantly improved survival of critically ill term and pre-term infants, but pose a unique challenge of exposure to multiple environmental toxins. In this review, we have summarized these exposures and the pathways through which they may negatively impact the neurodevelopmental outcomes in this highly vulnerable population. Ongoing environmental exposures in the NICU are a global healthcare problem and need policies and resources in place to mitigate their negative impact on infant and child health outcomes.